Individual
THERESA E WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
925 SPID DR, CORPUS CHRISTI, TX 78416-2347
(361) 851-6000
Mailing address
925 SPID DR, CORPUS CHRISTI, TX 78416-2347
(361) 851-6900
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
40918
CO
Other
Enumeration date
07/09/2024
Last updated
07/09/2024
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